Fired nurse fights back at Kaiser’s assertion that she had no right to patients’ files

In the wrongful-termination trial of nurse Ani Sanikian, Kaiser Permanente Fresno contends it has a clear-cut case as to why she was fired in May 2015: computer evidence proves she dug into the medical records of three patients without authorization.

Kaiser’s case for termination was bolstered a year later, its lawyers said, when Sanikian had to resign from Community Regional Medical Center in Fresno after getting caught digging into the medical record of one of her friends, a violation of hospital policy.

Sanikian, however, told a Fresno County Superior Court jury that she had a valid reason to look at the files of three Kaiser patients – it was her duty as a registered nurse to know their medical background before providing care to them. “Doctors rely on us to give them information,” she said. “If we don’t do it, no one will.”

She also explained why she looked at the file of the CRMC patient, an elderly woman: She said a doctor who’s a family friend urged her to check the medical record of his mother to ensure she was getting proper medical care. The doctor was willing to testify on her behalf, but the judge denied it.

In the second week of the trial, Sanikian, 46, of Fresno, spent two days on the witness stand, crying at times, but remaining steadfast that she had a right to look at the files. She also said she didn’t get a fair investigation and the computer evidence against her is suspect.

“It was like an ambush,” she told the jury.

In voicing her beliefs, she was admonished twice by Judge Jeffrey Hamilton for not directly answering questions posed by Kaiser’s lawyer, David McNamara. “This is not a time for speeches,” Hamilton told her in front of the jury.

And when Sanikian persisted, Hamilton told her outside the presence of the jury that she was “disrespecting the court.” Sanikian apologized, but she remained forceful throughout McNamara’s brutal cross-examination.

Afterward, Sanikian, the youngest of five children, said she gets her fighting spirit from her grandparents who survived the Armenian Genocide of 1915, and from her parents, George and Manoushag “Violet” Kasparian, who instilled in her “a moral compass” to face adversity and injustice.

She has sued the The Permanente Medical Group, a multibillion-dollar corporation of physicians who provide services to more than 11 million Kaiser Permanente members nationwide, including in Northern and Central California. Sanikian is seeking damages for wrongful termination, retaliation and defamation.

The trial is expected to take two more weeks. Testimony resumes Monday.

On the witness stand, some of Sanikian’s co-workers described her as a respected, passionate nurse and a champion of patient care. Other co-workers, though, said she was a bully who is vindictive when she doesn’t get her way.

Sanikian and her lawyers, Mick Marderosian and Heather Cohen, contend she was fired on trumped-up charges for being an outspoken advocate for patient care. In presenting the case, Marderosian has spoken of a more sinister plot – Kaiser using vague hospital policies and confidentiality laws to silence a nurse in order to prevent liability from patients.

But McNamara and co-counsel Christina Tillman, who represents the medical group, known as TPMG, bristle at Marderosian’s assertions. They contend Kaiser never retaliated against Sanikian. They said Kaiser did a thorough, independent investigation before firing Sanikian on May 12, 2015. “Its reputation depends on preserving the trust and confidentiality of its members,” McNamara said.

Sanikian, who is married with two children, began her medical career as a licensed vocational nurse at age 19. She began working for Kaiser in 2003. When she was fired, she was a registered nurse in the Pain and Spine Clinic, making about $75 an hour, or about $95,000 a year, plus health and vacation benefits and a retirement fund, she told the jury.

She testified she currently works for Urology Associates of Central California in Fresno, making about $39 an hour, or $64,000 a year, without benefits or a retirement fund.

“My life fell apart,” she said of receiving her termination letter, while crying on the witness stand. Sanikian said she stayed in her bedroom for at least a week before she could come to grips with her termination and seek counseling and medication for stress and depression.

The firing came at horrible time, Sanikian testified, because she was caring for her mother, who suffered a stroke, and her son was headed to college. “Kaiser was my career. It was my second home. It was my livelihood,” Sanikian said, while covering her face with her hands and sobbing on the witness stand.

Start of troubles

Sanikian testified her troubles began in the fall of 2014 when she saw a medical assistant come out of a room at the clinic, pulling up her scrubs. Soon after, she testified, she saw the clinic’s handsome doctor come out of the room.

Sanikian said she reported the incident to her manager, Suzanne Hollins. Afterward, the doctor and others in the office shunned her, she said.

Also in 2014, Sanikian said her nursing peers elected her to a Kaiser in-house committee that monitored nursing workload and presented concerns about patient safety to management. But when management ignored the nurses’ complaints, Sanikian had to regularly challenge Lily Tang, the director of nursing practices at Kaiser.

Their complaints came to a head in March 2015, Sanikian testified, when she and other committee members marched to the office of Tang’s boss, Lynn Campama, and gave her a signed petition regarding the lack of response to concerns about patient safety.

But on cross-examination, McNamara pointed out that the other outspoken nurses on the committee didn’t get fired. He also said Sanikian had been in trouble in 2013, when she was suspended without pay for three days for unprofessional conduct toward co-workers and for dishonesty.

“Unsubstantiated!” Sanikian shot back.

In December 2014, Sanikian was given in another discipline letter for yelling at a medical assistant in the clinic. A patient reported the complaint, McNamara said.

But Sanikian told the jury the medical assistant was the same one she had witnessed earlier. Sanikian said she was upset with the assistant for giving medical advice to a patient about going to the emergency room. “That is the job of a nurse,” Sanikian said.

Sanikian was given another letter in January 2015 for discharging a patient with a “saline lock,” or part of an IV, in the patient’s arm. Sanikian said it was an accident and that she corrected the issue before the patient left the hospital grounds. McNamara, however, noted that Sanikian never documented her mistake in the patient’s chart.

Sanikian also was tardy 19 times over a four-month period, starting in October 2014, McNamara said. Sanikian said she some of the tardys were for being late by one minute.

McNamara said Sanikian received annual training on Kasier’s confidentiality policies and had signed a document that said she would adhere to them. Despite all the training and warnings given to her about accessing patient records, McNamara said Sanikian’s “curiosity got the best of her.”

McNamara also said when Sanikian filled out the CRMC employment application she wrote she had never been fired. Instead, she said, she wrote she left for “personal reasons.”

Sanikian said a union representative told her to check to box that said she had never been fired. She told the jury if she checked yes, she would never find a job. (In her employment application to Urology Associates, she told them to call Kaiser’s human relations department, which is prohibited from revealing if she was terminated.)

Kaiser’s investigation

Suzy Joy, a senior Kaiser compliance officer, testified that she spent about 100 hours investigating Sanikian. Joy said Sanikian’s co-workers – registered nurses Janis Dirkes and Kathy Foster – in the Pain and Spine Clinic told Hollins about Sanikian’s alleged violation regarding one patient on Feb. 26, 2015. (On the witness stand, Dirkes denied telling Hollins about Sanikian’s alleged violation; Foster testified she did.) Hollins then contacted the compliance department.

Joy said her investigation revealed that Sanikian looked at the files of three patients without authorization. The patients were female Kaiser employees. In court they are referred to as patients A, B and C.

Joy testified that her interviews with Foster, Dirkes and Sanikian were not recorded, but she took copious notes on a computer. She did not interview the three patients whose records were read by Sanikian. She also said she was not a nurse, so she relied on what Foster, Dirkes and Sanikian told her to understand the roles of nurses in the clinic.

Joy testified the Kaiser policy regarding patient confidentiality is clear: employees are limited to “the minimum necessary” to perform their job duties. Employees also must have “a business need” to see patient files, she said.

She said computer evidence showed that Sanikian looked at Patient A’s file for 20 minutes on Feb. 26, 2015. Joy said Sanikian looked at such things as the patient’s history, medication, allergies and emails from the patient to the doctor. Joy testified that Sanikian had no business looking at the file because Dirkes was caring for Patient A.

Joy said she interviewed Sanikian in late March and early April. Sanikian brought a union representative with her, and when questioning became difficult, she asked for breaks, Joy told the jury.

Sanikian, however, told the jury that she was caught off-guard by Joy’s questions because the first interview took place a month after her co-workers told on her. She said she could not remember exactly what happened on Feb. 26 because by the time of her first interview she had seen at least 500 patients.

Sanikian testified that she thought she first looked at Patients A’s file back in October 2014, but was pretty sure she looked at the file in January and March. She testified she looked at the file because a doctor had asked her to get a syringe filled with Dilaudid, which is as addictive as heroin, and she wanted to make sure medicine was in accordance with the patient’s care.

“Looking at files from the beginning is the way I was taught,” she told the jury, describing herself as “old school.” In assessing a patient, “I’m going all the way back to when the symptoms started.”

But Joy testified the computer evidence from October 2014 to April 2015 showed that Sanikian only looked at Patient’s A file on Feb. 26, 2015. Sanikian, however, pointed out that the doctor also looked at the patient’s file around the same time she is accused of doing it.

Regarding Patient B, Joy testified, Sanikian looked at the file on Feb. 10, 2015, for 15 minutes, checking the patient’s history and emails, doctor notes and emergency contacts. Then on Feb. 26, 2015, Sanikian looked Patient B’s file again, for four minutes, looking at information she was not authorized to see, Joy told the jury.

Sanikian, however, testified that Patient B had called her and left a voice message about setting up an appointment. Sanikian said it was part of her job to look at the file.

Joy testified that Sanikian looked at Patient C’s file at six times, starting on Feb. 4, 2015. Joy said Sanikian was not providing care to the patient the first two times she looked at the file, but later was in charge of the patient’s care.

Sanikian, however, said the patient had a newly implanted pain pump and she wanted to make sure she wasn’t having problems with it. She told the jury she was still caring for the patient up to her termination.

Joy testified on cross-examination that Sanikian never shared the patients’ information with anyone. Because her actions had a “low probability” of harm, Joy testified, that Kaiser did not report it to state or federal authorities.

Maderosian pointed out that Joy, in her report, recommended that Sanikian be disciplined. She never wrote she should be terminated, Maderosian said.

But McNamara said Sanikian has a history at Kaiser of not accepting responsibility for her actions. He also told the jury that Sanikian’s last three or four evaluations gave her poor marks, causing Sanikian to shoot back. “They use personal evaluations to destroy your character,” she told the jury.

After all those years of service, Sanikian said she felt hurt because her supervisors never sat down and talked with her before she was terminated. In ending her testimony, Sanikian was asked by Marderosian if it was worth it to take on Kaiser, knowing McNamara would hammer at her character and reputation.

First, she trembled. Then she cried. “"Even if it kills me, I will speak out for patient safety until my dying day,” she said, crying on the witness stand.

This story was originally published August 27, 2017 at 1:32 PM with the headline "Fired nurse fights back at Kaiser’s assertion that she had no right to patients’ files."